THE CARDIAC CYCLE

BY:- SUDIPTA BHOWMICK BPT FINAL YR.

DEFINITION
It is defined as the sequence of co-ordinated events which take place during heart beat. Each heart beat consist of 2 major periods: Systole Diastole During systole there is contraction of cardiac muscle. During diastole there is relaxation of cardiac muscle.

DIVISION OF CARDIAC CYCLE

Contraction of atria = Atrial systole Relaxation of atria = Atrial diastole Contraction of ventricles = Ventricular systole Relaxation of ventricals = Ventricular diastole In clinical practice systole means ventricular systole & diastole means ventricular diastole.

Continue.
So cardiac cycle is divided in two phases:-systole -diastole

SUB DIVISION & DURATION OF CARDIAC CYCLE

When the heart beats at the normal rate of 72/min the duration of each cardiac cycle is about 0.8 sec. Duration of systole = 0.27sec Duration of diastole = 0.53sec

CONTINUE..
SYSTOLE Isometric contraction = 0.05sec Ejection period = 0.22sec DIASTOLE Protodiastole = 0.04sec Isovolumetric relaxation = 0.08sec Rapid filling phase = 0.11sec Slow filling phase = 0.19sec Atrial systole = 0.11sec

ATRIAL SYSTOLE

The end of diastole

ATRIAL SYSTOLE - Heart

It occurs during last phase of venticular diastole. Also called as second or last rapid filling phase or presystole. Lasts for 0.11sec, Prior to atrial systole, blood has been flowing passively from the atrium into the ventricle through the open AV valve. During atrial systole the atrium contracts and tops off the volume in the ventricle with only a small amount of blood. Atrial contraction is complete before the ventricle begins to contract.

ATRIAL SYSTOLE Pressures & Volumes

The "a" wave occurs when the atrium contracts, increasing atrial pressure slightly about 5mmHg(yellow). Atrial pressure drops when the atria stop contracting.

ATRIAL SYSTOLE ECG

An impulse arising from the SA node results in depolarization and contraction of the atria (the right atrium contracts slightly before the left atrium). The P wave is due to this atrial depolarization. The PR segment is electrically quiet as the depolarization proceeds to the AV node. This brief pause before contraction allows the ventricles to fill completely with blood.

ATRIAL SYSTOLE Heart Sounds

A fourth heart sound (S4) abnormal and is associated with the end of atrial emptying after atrial contraction. It occurs with hypertrophic congestive heart failure, massive pulmonary embolism, tricuspid incompetence, or cor pulmonale.

ISOVOLUMETRIC CONTRACTION

The Beginning of systole

ISOVOLUMETRIC CONTRACTION Heart

Last for 0.05sec In the beginning of venticular contraction semilunar valves are closed but the AV valves are not firmly closed. As the contraction starts he IV pressure rises & AV valves closes firmly. Ventricles contract as a closed chamber. As the presssure rises steeply AV valve bulges inside the atria Mechanically it is a phase between closing of AV valve & opening of semilunar valve..

ISOVOLUMETRIC CONTRACTION Pressures & Volumes

The AV valves close when the pressure in the ventricles (red) exceeds the pressure in the atria (yellow). As the ventricles contract isovolumetrically -- their volume does not change (white) -- the pressure inside increases, approaching the pressure in the aorta and pulmonary arteries (green). The cwave in atrial pressure curve(yellow)is seen at this time & is due to the buldging of AV valves with in the atrum which causes slight increase in atrial pressure.

ISOVOLUMETRIC CONTRACTION ECG

Ventricular complex of ECG begins slightly before this phase,so later half of R WAVE is in this phase. The QRS complex is due to ventricular depolarization, and it marks the beginning of ventricular systole. It is so large that it masks the underlying atrial repolarization signal. the ventricles to fill completely with blood.

ISOVOLUMETRIC CONTRACTION Heart Sounds

The first heart sound (S1, "lub") is due to the closing AV valves and associated blood turbulence.

RAPID EJECTION

RAPID EJECTION Heart

As soon as the IV pressure exceeds hydrostatic pressue of aorta,the semilunar (aortic and pulmonary) valves open and due to contraction of ventricles, blood is ejected out rapidly from both ventricles. Lasts for 0.13sec.

RAPID EJECTION Pressures & Volumes

Volume in the ventricles decreases rapidly (white). Aortic pressure rises steeply but it remains lower than that of ventricles. As more blood enters the arteries the presssure there builds until the flow of blood reaches the peak.

RAPID EJECTION ECG

ST segment occurs in this phase

RAPID EJECTION Heart Sounds

None

REDUCED EJECTION

The end of systole

REDUCED EJECTION Heart

It is end of systole. Lats for about 0.15sec. During this rate of ventricular ejection falls, total blood ejected is less than that in rapid ejection phase.

REDUCED EJECTION Pressures & Volumes

After the peak in ventricular and arterial pressures (red and green), blood flow out of the ventricles decreases and ventricular volume decreases more slowly (white). The rate of run off exceeds the rate of inflow into the aorta, so aortic blood pressue falls. mean while ventricular pressure also falls & a time comes when IV pressure falls below the aortic pressure. This marks the end of ejection phase.

REDUCED EJECTION ECG

The T wave is due to ventricular repolarization. The end of the T wave marks the end of ventricular systole electrically.

REDUCED EJECTION Heart Sounds

None

PROTODIASTOLE

It is the first stage of ventricular diastole. Lasts for 0.04sec Due to ejection of blood, the pressure in pressure in aorta & pulmonary artery increases & pressure in ventricles drop. When the IV pressure decreases than aortic & pulmonary pressure the semilunar valves closes. AV valves are already closed so no other changes occur in heart during this phase.

ISOVOLUMETRIC RELAXATION

ISOVOLUMETRIC RELAXATION Heart

Starts with the closure of semilunar valve. Lasts for 0.08sec AV valves are still closed. Therefore the ventricles act as closed cavity & at the same time ventricles start relaxing. Hence here is no change in length & volume of muscle fibres.

ISOVOLUMETRIC RELAXATION Pressures & Volumes

Throughout this phase the atrium in diastole has been filling with blood on top of the closed AV valve, causing atrial pressure to rise gradually (yellow). The "v" wave is due to the back flow of blood after it hits the closed AV valve. The pressure in the ventricles (red) continues to drop and may reach 0mmHg. Ventricular volume (white) is at a minimum and is ready to be filled again with blood.

ISOVOLUMETRIC RELAXATION ECG

No Deflections

ISOVOLUMETRIC RELAXATION Heart Sounds

The second heart sound (S2, "dup") occurs when the semilunar (aortic and pulmonary) valves close. S2 is normally split because the aortic valve closes slightly earlier than the pulmonary valve.

RAPID VENTRICULAR FILLING

RAPID VENTRICULAR FILLING Heart

Once the AV valves open, blood flows from the atrium to ventricles with a gush. About 70% filling of the ventricles occurs during this phase. Lasts for about 0.19sec

RAPID VENTRICULAR FILLING Pressures & Volumes

Ventricular volume (white) increases rapidly as blood flows from the atria into the ventricles. The atrial pressure falls slightly but still remains more than that of ventricles.

RAPID VENTRICULAR FILLING ECG

No Deflections

RAPID VENTRICULAR FILLING Heart Sounds

A third heart sound (S3) is usually abnormal and is due to rapid passive ventricular filling. It occurs in dilated congestive heart failure, severe hypertension, myocardial infarction, or mitral incompetence.

REDUCED VENTRICULAR FILLING

(Diastasis)

REDUCED VENTRICULAR FILLING Heart

After the sudden rush of blood, the ventricles filling slows. About 20% of the filling occur s during this phase. It lasts for 0.19sec

REDUCED VENTRICULAR FILLING Pressures & Volumes

Ventricular volume (white) increases more slowly now. The ventricles continue to fill with blood until they are nearly full.

REDUCED VENTRICULAR FILLING ECG

No Deflections is seen but it usually corresponds the phase between the end of T wave & next P wave.

REDUCED VENTRICULAR FILLING Heart Sounds

None

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